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Discussing obesity with patients

What we cover:

1. Importance of timely intervention

Recent estimates suggest that half of the world's population will be living with overweight or obesity by 2035.1 In New Zealand alone, approximately 2 in 3 adults are currently living with overweight or obesity.2 The ACTION IO* survey found that on average it took 6 years between the time that people living with obesity first began struggling with excess weight or obesity and when they had their first weight management conversation with a healthcare professional.3 As overweight and obesity have been associated with an increase in all-cause mortality,4 initiating weight management conversations at an early stage in patients with BMIs in the overweight category may play an important role in combating the increasing prevalence of obesity and higher BMIs that is becoming commonplace in today's society.

2. Employing an empathetic approach

The complex and sensitive nature of obesity can make conversations difficult to have with patients. An empathetic approach and asking permission is a helpful starting point. Results from ACTION IO showed that 2 in 3 people living with obesity would like their healthcare professional to bring up their weight.3

Research indicates that when healthcare professionals employ an empathetic approach and other techniques consistent with motivational interviewing, patients are more likely to attempt weight loss through changes in eating and activity habits.5

3. Ask permission

When opening the conversation it’s important to ask for permission as talking about weight may be a sensitive topic.6

"Would it be alright to discuss your weight today?"

Once you have permission to discuss weight, ensure you use positive, motivational and patient-first language at all times.7 Below are two examples of how to discuss obesity with your patient, one is best practice and the other is language you should avoid.

"Would you mind if we discussed your weight today and put together a weight management plan?"

"I have noticed you are obese, have you tried eating less and moving more?"

If a patient does not give permission and doesn’t want to have a discussion about their weight, do not push it further and inform them that you will be available to discuss it in the future if they change their mind.6

4. Other things to consider

As you initiate the conversation with your patient with obesity, it is recommended to advise about the health risks associated with obesity.6

To balance the discussion of health risks associated with excess weight, consider advising your patient on how a weight loss of 5% has significant health benefits, and a sustained weight loss of 10–15% or more can further enhance these benefits and provide additional improvements to health.8-14

Below are some talking points:

"Because of your weight, you are also at risk of developing several weight-related complications including high blood pressure, coronary heart disease and diabetes." 15

"With weight loss of as little as 5% you can achieve significant health benefits, and a sustained weight loss of 10-15% or more can further enhance these benefits and provide additional improvements to your health." 8-14

For more information on obesity-related complications, click here.

In this video, Dr Sandy Van invites you to consider treating obesity like you would any other chronic medical condition like diabetes, or cardiovascular disease - with a comprehensive plan that not only includes lifestyle treatment, but also evidence-based interventions. Although Dr Van is based in Canada, the management approach she discusses is relevant to the New Zealand healthcare setting.

*The Awareness, Care and Treatment in Obesity MaNagement – an International Observation (ACTION IO) Study is the first international study to investigate barriers to obesity management among people with obesity and healthcare professionals in 11 countries worldwide. A total of 14,502 people with obesity and 2,785 healthcare professionals completed the survey.3

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References

  1. World Obesity. World Obesity Atlas 2023. Available at: https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023 (Accessed August 2024).
  2. Ministry of Health NZ Health Survey. Available at: minhealthnz.shinyapps.io/nz-health-survey-2022-23-annual-data-explorer/_w_32694b71/#!/explore-indicators (Accessed August 2024).
  3. Caterson ID, et al. Diabetes Obes Metab. 2019;21:1914–1924.
  4. The Global BMI Mortality Collaboration. Lancet. 2016;388:776–786.
  5. Pollak K, et al. J Fam Pract. 2007;56:1031–1036.
  6. Vallis M, et al. Canadian Family Physician. 2013;59:27–31.
  7. Wadden T, Didie E. Obesity Res. 2003;11:1140–1146.
  8. Knowler WC, et al. N Engl J Med. 2002;346:393–403.
  9. Wing RR, et al. Diabetes Care. 2011;34(7):1481–1486.
  10. Dattilo AM, Kris-Etherton PM. Am J Clin Nutr. 1992;56(2):320–328.
  11. Coggon D, et al. Obes Relat Metab Disord. 2001;25(5):622–627.
  12. Christensen R, et al. Ann Rheum Dis. 2007;66(4):433–439.
  13. Zelber-Sagi S, Godos J, Salomone F. Therap Adv Gastroenterol. 2016;9(3):392–407.
  14. Glass LM, et al. Dig Dis Sci. 2015;60(4):1024–1030.
  15. Must A, et al. JAMA. 1999;282:1523–1529.
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